Nonfocused Enhanced CT Evaluation of Acute Appendicitis Increases Length of Stay in the Emergency Department but Does Not Increase Perforation Rate

Abstract

Nonfocused enhanced CT (NFECT) using intravenous and oral contrast is highly sensitive and specific for the diagnosis of acute appendicitis but requires additional time for transit of oral contrast and imaging interpretation. The aim of this study was to review our use of NFECT for the evaluation of acute appendicitis. Over a 2-year period, 295 adult patients presented to our emergency department and were diagnosed with acute appendicitis. Of these patients, 240 (81%) had undergone some form of cross-sectional imaging of the abdomen, and the majority (n = 193 [65%]) had NFECT scans performed during their evaluation. Fifty-five (19%) patients did not undergo cross-sectional radiographic evaluation (nonimaging group). Compared with the nonimaging group, patients who underwent NFECT were older (37 vs 32 years; P = 0.015) and more likely to be female (49% vs 20%; P < 0.001). Length of stay in the emergency department was significantly greater for patients who underwent NFECT (606 vs 321 minutes; P < 0.001), but there was no significant difference in the rate of acute appendiceal perforation (15% vs 9%; P = 0.297). In conclusion, use of NFECT for the diagnosis of acute appendicitis nearly doubles the patient's time in the emergency department with no significant increase in the acute perforation rate.